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Feb 13 09 08: 18a Elite Iv Contractors Inc 2094616342 <br /> • • p. 3 <br /> Pugs. or 2�. <br /> SWRCB,January 2002 <br /> Secondary Containment Testing Report Form <br /> Thi.v./hrm iR iolanel el,Jor use Iry curnrcreronv per,-fiwm lg ptTiudi['IRv/ill,Q t)J(i$T.�'CCnn(lUN cmdairnner'll VYNIems. Use 1110 <br /> npproprfo2'prr};ev gJ'rhis,/nrur ro r•epur-1+Ya'ulle Jnr all compot2•n1N IVNICJ. The t:nmplek•c/Jirrnr, written lc••vl p1weedures.ernef <br /> pf-mlo is 1kom awry fit ipIplicuhlu/,should he provided rn jh,./irrilflc•rrwncr/uprrurrrr/br.ruburflrcd fu the!Dent r'c}{ulalom crgrr+rt'. <br /> 1. FACU..1'rY INFORMATION <br /> Dale of"I'csling_,2,_� .---- <br /> Focilily Nume: 1�'(�' t�G1rl _ '�^--- _ <br /> _ l /rJ�,�'^n <br /> FacilityAddre_ti: �� ! -- <br /> Phone: --.--. <br /> FacilitvContnet: --- <br /> Date Local Agency W:rs Nutiticd orr.csling_ /A) <br /> Nam,of Local Agcmv Inspector01'prevent abrrir L revrht+k I <br /> 2. ,ITSI TING CONTRACTOR INFORMA-CION -- <br /> CnnlpanyNanic: 1 r�d� . ---- <br /> Tcchnicinn C'ondu in;0'e A: •' c i..lrCx---- -- --•-- ----'— <br /> Cralentials:_ (251.8 Licensed Contrrclor i SW RCLi Licensed Tunk l'ester -- <br /> License'Iyp,: — --' License Number: 00 <br /> M anafacl u rer'1'raining <br /> Manulactur,r __ _C'nmpnncnl(a) —._---. Date rainin �T_s <br /> r <br /> 3. SUMMARY Or TEST RESULTS <br /> Not Repairs r Nnt Itcpmrs <br /> Component pass Fail Component Patin fall •Tested blade <br /> 'I'mted Made __ _ <br /> l! II F1 r. i a <br /> _ —. <br /> 1 I II l I ❑ J <br /> LI i u G _I <br /> J n <br /> I _1 <br /> -1 <br /> I I —I u — L —I I <br /> —.. <br /> J I u L, , _I <br /> I I F1 <br /> I1'hydrostalic Ic+lin was performed,deserihc what was done with the water tHhr cumplo.ion of tests: <br /> CERTIFICATION OF TECIINICIAN RESPONSIBLE FOR CONDUC-1-INC'1'1115'PF.STINC <br /> To Nre best#f„r y knonded(•e,rhe faetx.wrded in this doernnent are accurate and in full compliance with legal rerfuirvuenta <br /> Technicinn-sSign:aard Dale; <br />